Instructions - Waiver Application, Licensed 10 - 19 Years
“Waiver” means that you have previously passed the EPPP with a score that meets or exceeds the pass-point requirement for Arizona.
By selecting the application type, “Waiver – Passed the EPPP Part 1 & licensed as a psychologist at the independent level for 10 or more years and less than 20 years”, you are providing written statement to the Board that you are requesting to waive the following requirements:
- Taking and passing EPPP Parts 1 & 2. Your passing EPPP score must be transferred from ASPPB to the Arizona Board. To transfer scores, visit ASPPB’s Score Transfer page.
- Verification of the additional 1,500 hours of supervised experience. With 10+ years of independent licensure, these verifications are NOT needed. Verification of a minimum 1,500 hours of internship is required per A.R.S. Section 32-2071(D) & (F).
Applicant Must Submit:
- Completed online application and $350 application fee, paid online with submission of application.
- Completed and signed Arizona Statement of Citizenship and Alien Status form (All applicants must sign form on page 2, Section IV.)
- Copy of your current government issued picture ID such as your U.S. passport, Real or enhanced ID (driver’s license or ID card), or other acceptable documentation. Please note, if the documentation, such as a birth certificate, does not have your picture, you must also send a copy of a valid picture ID such as a driver’s license, US passport, military ID, etc. See the Evidence List on page 3 of the Statement of Citizenship form for a list of acceptable ID.
- Self-query from the National Practitioner Data Bank (NPDB) available at www.npdb.hrsa.gov. To be acceptable, the Board must be able to validate the electronic signature. Therefore, please submit/upload the original PDF downloaded from the NPDB’s website. Printouts or mailed copies are not acceptable.
- One original photograph taken not more than 60 days before the date of your application submission. This may be a photo taken with a digital camera or smartphone as long as it is high resolution, just head and shoulders like a photo on an ID, facing front, plain background, in focus, good lighting, etc. (“passport quality”)
- If doctoral program was not accredited by APA or PCSAS, you must submit a completed Core Program Requirements form. You may list applicable graduate courses from a Master’s and/or Doctoral program to fulfill requirements in the categories listed on the form. Undergraduate coursework is not acceptable. First read the instructions at the top of the form. Accuracy is paramount. You may wish to submit a course catalog or syllabi to support your choice for content area.
- If applicable, documentation for YES answers to professional conduct questions. See “Additional Documentation for YES Answers” for details regarding the documents required for your Yes answer(s). Your application will not be administratively complete without this appropriate documentation.
Applicant Must Cause to Be Sent by Verifier:
Sent by email to [email protected] is preferable.
- Official transfer of score(s) from ASPPB.
- Verification of minimum 1,500 hours of internship, which was completed within 24 consecutive months and meeting all other requirements for internships in A.R.S. Section 32-2071. Please note, regardless of doctoral program or requirements in the state where the internship was completed, all requirements for internships delineated in this statute must be met for the internship to be approved for licensure in Arizona. There are no exceptions in statute or rule that allow the Board to accept an internship that is lacking in even one requirement. Applicants must complete the top portion of the Internship Verification form and submit to their supervisor or current licensed psychologist who is the official custodian of records for the internship. Download the Internship Verification form HERE. The verifier must email the verification to [email protected]. (The psysubmissions email address is strictly for submissions. Questions should be emailed to the Board's licensing specialist at [email protected].)
- Official transcripts from all graduate institutions attended, regardless of degree, sent directly to the Board by the university/college (transcripts sent electronically will be accepted if the Board can validate the transcripts). These are sent most often by a school’s contracted third-party such as Parchment, National Student Clearinghouse, etc. Provide the email address, [email protected] for electronic delivery to the Board’s office.
- Verification of all psychology licenses or other professional licenses (may also be referred to as registrations or certifications) ever held in other states/provinces, sent directly to the Board of Psychologist Examiners by the issuing agency or board. This includes PSYPACT. All licenses ever held must be verified regardless of current status. Online verifications may be accepted ONLY IF the online license verification or license look-up states in writing that it may be considered primary source verification and the site’s disclaimer does not negate this statement. Provide the email address, [email protected], for electronic delivery to the Board’s office.
- Completed reference forms: The Board will contact these persons directly for the required information and endorsement on forms provided by the Board.
To be acceptable, reference psychologists must be familiar with the applicant's work experience in the field of psychology or postdoctoral program within three (3) years immediately preceding the date of application.
If more than three (3) years have elapsed since the applicant last engaged in professional activities in the field of psychology or in a postdoctoral program, the references may be from the most recent three-year period in which the applicant engaged in professional activities in the field of psychology or in a postdoctoral program (R4-26-203(A)(26)).
If (b), above, the applicant must provide a written explanation of professional history since they last practiced in the field of psychology including dates.
Mere provision of a signature or an unfavorable report by a reference psychologist does not constitute provision of credentials necessary for licensure.
Reference psychologists shall be psychologists licensed or certified to practice psychology in a United States or Canadian jurisdiction.
Members of the Arizona Board of Psychologist Examiners cannot provide references.
The Board may reject any reference and/or require additional references from the applicant.
STATUTES AND RULES
Arizona licensees are expected to know the statutes and rules regulating the practice of Psychology in Arizona. You may download a free copy of the Statutes and Rules from the Board's website.
CONTACTING THE BOARD
Document submissions: For transcripts, supervised experience verifications, license verifications, etc., please provide the email address, [email protected], to verifiers.
Kathy Fowkes, Licensing Specialist
Email: [email protected]
Direct Line: (602) 542-8161
Fax: (602) 926-8095
Arizona Board of Psychologist Examiners
1740 West Adams Street, Suite 3403
Phoenix, Arizona 85007
NOTICE FOR AMERICANS WITH DISABILITIES
Title II of the Americans with Disabilities Act (ADA) prohibits the Board from discriminating on the basis of disability in its public meetings. Persons with disabilities may request reasonable accommodations by contacting the Board at (602) 542-8162 to make their needs known. Requests should be made as soon as possible to allow time to arrange for accommodations. These documents may be made available in alternative formats by contacting the Board.
With respect to licensing decisions, please note that A.R.S. §41-1030 provides that:
B. An agency shall not base a licensing decision in whole or in part on a licensing requirement or condition that is not specifically authorized by statute, rule or state tribal gaming compact. A general grant of authority in statute does not constitute a basis for imposing a licensing requirement or condition unless a rule is made pursuant to that general grant of authority that specifically authorizes the requirement or condition.
D. This section may be enforced in a private civil action and relief may be awarded against the state. The court may award reasonable attorney fees, damages and all fees associated with the license application to a party that prevails in an action against the state for a violation of this section.
E. A state employee may not intentionally or knowingly violate this section. A violation of this section is cause for disciplinary action or dismissal pursuant to the Agency's adopted personnel policy.
F. This section does not abrogate the immunity provided by section 12-820.01 or 12-820.02.
Pursuant to Section 41-1093.01, Arizona Revised Statutes, an agency shall limit all occupational regulations to regulations that are demonstrated to be necessary to specifically fulfill a public health, safety or welfare concern. Pursuant to Sections 41-1093.02 and 41-1093.03, Arizona Revised Statutes, you have the right to petition this agency to repeal or modify the occupational regulation or bring an action in a court of general jurisdiction to challenge the occupational regulation and to ensure compliance with Section 41-1093.01, Arizona Revised Statutes.